Embrace the Complexity of Marijuana Use in Adolescents

Embrace the Complexity of Marijuana Use in Adolescents

Article excerpt

REPORTING FROM NPA 2018

LAS VEGAS -- When talking with adolescents and their families about marijuana use, Kevin M. Gray, MD, recommends embracing the complexity of the issue.

'Avoid polarizing this topic and avoid vilifying cannabis," he advised at an annual psychopharmacology update held by the Nevada Psychiatric Association. "Take an interest in what they have to say about cannabis. Work in a gentle, nonconfrontational way where you avoid polarization and find some common ground where you can agree that maybe there's some good and some bad [about cannabis], but the overwhelming evidence in adolescents is that there's more harm than good with cannabis use, particularly recreationally."

To illustrate the complexity, he noted that cannabis can be safe and benign, can contain medicinal components, and can be risky and harmful. "These can all simultaneously be true, and it's important for patients and families to understand that," he said. "Opening a discussion that way is much more productive than saying, 'This is bad for you.'"

Dr. Gray, professor and director of child and adolescent psychiatry at the Medical University of South Carolina, Charleston, acknowledged that clinicians face a delicate balance between risk and benefit, even among Food and Drug Administration-approved medications. However, teens and families may struggle with these nuances, especially in light of the term "medical marijuana." Some assume that "medical" implies "beneficial." Others may equate "marijuana" with "natural," which they may, in turn, equate with being "harmless."

"Perception is critically important," Dr. Gray said at an annual psychopharmacology update held by the Nevada Psychiatric Association.

Cannabis initiation typically occurs during adolescence, and rates of initiation and use are increasing. According to Dr. Gray, 55% of U.S. high school seniors have used marijuana, 23% use currently, and 6% use daily. "Those are the ones who have adverse outcomes," he said. Young users are particularly prone to dependence symptoms and an inability to cut back their use. The odds of meeting criteria for cannabis use disorder are substantially greater in adolescent users than they are in adults regardless of time frame or intensity of use. …